New Mindful Birthing Essentials Scholarship

4-Week Mindful Birthing Essentials - Scholarship Request
At the Mindful Birthing and Parenting Foundation, we recognize that financial challenges can make it difficult for some individuals to access Mindful Birthing Essentials. To help, we offer scholarships to those from strategically underserved or marginalized communities, as well as those experiencing financial hardship. Each application is carefully reviewed on a case-by-case basis.
Mindful Birthing Essentials Class Series
Please select the class series you wish to apply for from the drop down*
Personal Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
Registration Type*

SingleCouple
Are you the Pregnant Person or the Partner*

Pregnant PersonPartner
Partner Name

First NameLast Name
Partner's Email
example@example.com
Partner's Phone Number

Area CodePhone Number
Expected Due Date*

MonthDayYear
Date
What country are you located in?*
What state in the US are you located in?
Financial Information
Note: Standard Participant Rates: Singles - $195; Couples - $275
(currency converter: https://www.xe.com/currencyconverter/)
What is your current total annual household income (before taxes)? Please select the appropriate income range*

Less than $20,000$20,000 – $49,999$80,000 – $109,999$110,000 – $149,999$150,000 or more

Please select the option that best describes your level of disposable income at the end of each month*

Rows	Considerable	Moderate	Minimal	None
Disposable Income at the end of the month

What is your financial need?*

You can afford to attend the program without a scholarshipYou can afford to attend the program without a scholarship but it would cause financial hardshipYou CANNOT attend the program without a scholarship
How much of the course fee are you able to contribute towards?*

I can contribute 75% of the program fee - payment for Singles = $146.25; Payment for Couples = $206.25I can contribute 50% of the program fee - payment for Singles = $97.50; Payment for Couples = $137.50I can contribute 25% of the program fee - payment for Singles = $48.75; Payment for Couples = $68.75I can not contribute any of the program fee - no payment. Note: this will only be awarded in exceptional circumstances (see text at the top of the form)
Calculated Scholarship Percentage
Community and Identity Information
Do you identify as a member of a marginalized or underrepresented group? (you may choose more than one)*

Rural familiesGlobal Majority families (Black, Indigenous, People of Color)Unhoused familiesMilitary familiesTwo spirit, lesbian, gay, bisexual, trans, queer/questioning, intersexed, asexual (LGBTQIA+)Recent immigrant familiesFamilies affected by substance useInternally displaced familiesOther (please specify below)
Are you living in an underserved community? (you may choose more than one)*

I live in an economically disadvantaged areaI live in a rural or remote area with limited access to servicesI live in an area with limited access to quality educational opportunitiesI live in an area with limited access to healthcareI live in a low-income householdNone of the aboveOther (please specify below)
Motivation and Commitment
Why are you interested in attending the Mindful Birthing Essentials course? (you may choose more than one)*

I read the Mindful Birthing book and want to learn more in a structured, interactive settingIt was recommended to me by a friendIt was recommended to me by a birth workerI want to learn mindfulness skills for managing stress during pregnancy and birthI want to enhance emotional connection with my partner/familyI want to prepare for childbirth in a mindful, calm wayI want to feel more confident and empowered during labor and birthI want my partner and I feel more connected during the birth processI want to reduce fear or anxiety about childbirthI want to support a positive mental health experience during pregnancy and postpartumI want to build a supportive community with other expectant parentsI want to address past traumatic birth experiencesOther (please specify below)
How do you hope Mindful Birthing Essentials will benefit you and your family? (you may choose more than one)*

Improve emotional well-being during pregnancyStrengthen the bond with my partner and familyEnhance communication and understanding with my partnerProvide tools for handling stress and challenges in parenthoodIncrease confidence and mindfulness in parentingBuild a sense of community with other parentsPromote a more positive birth experience for the whole familyOther (please specify below)
Special Considerations
Are there any additional factors or life circumstances that you would like us to consider in reviewing your scholarship application? (e.g., single parent, recent job loss, refugee status, etc.)*
Confidentiality Notice:

The information you provide on this form is strictly confidential and will only be reviewed for the purpose of determining scholarship eligibility. This information will not be shared with faculty. Aggregate, anonymous data may be used for statistical or reporting purposes.
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4-Week Mindful Birthing Essentials - Scholarship Request

Mindful Birthing Essentials Class Series

Personal Information

Financial Information

Community and Identity Information

Motivation and Commitment

Special Considerations